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HomeMy WebLinkAboutJOSHUA BOBROVE (2)N-2021-025-01 MAYOR Vicente Sanniento MAYOR PRO TEM CV Phil Bacerra o COUNCILMEMBERS CV Johnalhan Ryan Hernandez C3) Jessie Lopez p Nelida Mendoza David Penaloza C-13 Thai Viet Phan INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES l i • l el • 22�2'z CLERK OF COUNCIL DATE: Joshua Bobrove 2419 Vista Del Campo Santa Barbara, CA 93101 Attn: Joshua Bobrove Li% CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Daisy Gomez CITY OF SANTA ANA PUBLIC WORKS AGENCY 20 Civic Center Plaza • P.O. Box 1988 Santa Ana, California 92702 wW W.santa-ana orc December 13, 2021 Re: Extension of Agreement for Commercial Photography Services, No. N-2021-025 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Joshua Bobrove and the City of Santa Ana, dated December 16, 2020, the time period of the Agreement is hereby extended for an additional two-year period, from December 16, 2021 through December 15, 2023. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, Nabil Saba, P.E. Executive Director, Public Works Agency CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM Sonia R. Carvalho City Attorney `B ndon Salvatierra Deputy City Attorney ATTEST 1. Daisy Gomez, MMC t,w-Clerk of the Council CONSULTANT JdZua Bobrove Owner SANTA ANA CITY COUNCIL Vicente sanniento Phil Bacena Thai Viet Phan Drool Penalonr Jessie Lopez Johnathan Ryan Hernandez Neltla Mend.. Mayor Mayor Pro Tern, Ward 4 Ward t Ward 2 Ward 3 Wand 5 Ward 6 s..,arn.daants-anaor 26arance- ea - tphan(Asanta-anaara dpenalouasaarlaaaa ant nanthernandozOsenta-anantl THAITHE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92701 Account Information: Policy Holder Details : PHOTOGRAPHY BY JOSHUA BOBROVE March 10, 2022 %Q Contact Us Business Service Center Business Hours: Monday - Friday (7AM - 7PM Central Standard Time) Phone: (866) 467-8730 Fax: (888) 443-6112 Email: agency.services(a)thehartford.com Website: hftps://business.thehartford.com Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTR005 M6APagt misw ReneusDAPPROVED BY. ® Risk Management Spedaliss .nco�rd CERTIFICATE OF LIABILITY INSUA04je Digitally sign &`TE(MMIDDIYY" U 03/10/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONF RS NO RIGHT4UP614THIMIERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTF lC3PEAV@QF Awila& AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B TWM�e;: �1i4j11Qj®( _NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLD 1 5.1 3-37117'!1 ' IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ley must bs endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HILL & USHER INS & SURETY/PHS 59302202 CONTACT NAME' PHONE (866) 467-8730 INC, No, Earl: uc No):(888) 443-6112 The Hartford Business Service Center E-MAIL 3600 Wiseman Blvd San Antonio, TX 78251 ADDRESS: INSURER(5)AFFOROING COVERAGE NAICp INSURED INSURERA: Sentinel Insurance Company Ltd. 11000 INSURERB: PHOTOGRAPHY BY JOSHUA BOBROVE 2419 VISTA DEL CAMPO SANTA BARBARA CA 93101-4662 INSURER C : INSURER D : INSURER E : INSURER F : CERTIFICATE NUMBER: KEVISIUIq NUMBER: y THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR VIVO MM/DO M IDDTY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $1,000,000 CLAIMS -MADE OCCUR lxl PREMISES Eaamunence M ED EXP(Any am Person) $10,000 X General Liability A X 12/19/2021 12/19/2022 PLRSONAL&ADV INJURY $1,000,500 GEN'LAGGREGATE LIMITAPPLIES PER. GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 POLICY ❑ PRO LOC RX ECT OTHER: COMBINEDSINGLE LIMIT $1,000,000 AUTOMOBILE LIABILITY Ea accitlenf BODILY INJURY (Per person) ANY AUTO BODILY INJURY (Per accident) A ALL OWNED SCHEDULED 12/19/2021 12/19/2022 AUTOS AUTOS HIRED NON -OWNED PPReOPPeRtlTYDAMAGE X X AUTOS AUTOS OCCUR EACH OCCURRENCE UMBRELLA LIAB AGGREGATE EXCESS LIAB CLAIMS- MADE ED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER E.L. EACH ACCIDENT ANY YIN PROPRIETORIPARTNERIEXECUTIVE NIA E.L. DISEASE -EA EMPLOYEE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DESCMP77ON OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. RE: N-2021-025. City of Santa Anna, its officers, employees, agents & representatives are additional insured per the Business Liability Coverage Form SS0008 attached to this policy. Notice of Cancellation will be provided in accordance with Form SS1223, attached to this policy. City of Santa Ana SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Risk Management Division BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 20 Civic Center Plaza, 4th Floor IN ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD COF REVIEWED 6 APPROVED BY: ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD `!4 11 co' A+1P Auv44 '® Risk Management Speazh51: AGENCY CUSTOMER ID: LOC#: ADDITIONAL REMARKS SCHEDULE �Page 2 of 2 AGENCY NAMED INSURED HILL & USHER INS & SURETY/PHS PHOTOGRAPHY BY JOSHUA BOBROVE POLICY NUMBER 2419 VISTA DEL CAMPO SEE ACORD 25 SANTA BARBARA CA 93101-4662 CARRIER NAIC CODE SEE ACORD 25 EFFECTIVE DATE: SEE ACORD 25 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Coverage is primary and noncontributory per the Business Liability Coverage Form SL 00 00, attached to this policy. CITY WILL BE MAILED 30 DAYS WRITTEN NOTICE OF POLICY CANCELLATION AND THE REFERENCES "ENDEAVOR TO" AND "FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES' SHALL BE REMOVED OR CROSSED OUT. WakMansganer&WslDn R20EWM & APPROVED Br. ACORD 101 (2014/01) C 2014 ACORD CORPOF `�7 4p ANw..� The ACORD name and logo are registered marks of ACORD Risk Management specialist